Minimally Invasive Spinal Fusion for the Lower Back (Lumbar Spine): Minimally Invasive Direct Lateral Interbody Fusion (MIS-DLIF)

Overview of Minimally Invasive Direct Lateral Interbody Fusion (MIS-DLIF)

About 60% of Americans are affected by chronic low back pain at some point in their life, leading to an estimated cost of $635 billion in medical bills, and loss productivity. The treatment for this condition is fusion of the lumbar spine which is located in the lower back. Fusion of the lumbar spine is when two or more vertebrae of the lumbar spine is fused together to reduce movement leading to some or complete pain relief. Fusion of the lumbar spine can be used for the treatment of degenerative disk disease (the degeneration of the disk between the vertebrae that may be due to natural stress or injuries), herniated disk (bulging of the disk between the vertebrae that may cause pain and compression of the nerves) or other issues in the spine.

The minimally invasive keyhole direct lateral interbody fusion (MIS-DLIF), also known as the extreme lateral interbody fusion (XLIF) is gaining popularity as it decreases surgical cost, reduces surgical time, decreases duration of hospital stay for patients and decreases the healing time needed for patients. This is due to the minimally invasive keyhole technique that requires smaller incisions and minimal disruption of surrounding structures around the spine leading to lesser pain and smaller scars after surgery.

Compared to their minimally invasive keyhole counterparts, traditional surgeries require a longer incision for the surgeon to be able to access and view the anatomy of the patient leading to longer hospital stays and lengthy recovery times.

According to several studies, it has been found that the MIS-DLIF is a safe and clinically safe procedure. It has also been said to be easier to master compared to other minimally invasive keyhole fusion surgeries as it does not require direct visualization. Studies have also confirmed that the MIS-DLIF the surgery time and duration of hospital stay for patients are significantly lower. There is also less blood loss and approximately 50% of patients do not even require overnight hospitalization. This means that MIS-DLIF may soon be performed as an outpatient (patients are not required to stay overnight in the hospital) procedure contributing to reduced medical costs.

Unlike other minimally invasive keyhole lumbar fusion surgeries, MIS-DLIF can be performed on almost all levels of the lumbar spine. Studies have also found that the average time for an MIS-DLIF procedure takes approximately 44 minutes for a single level vertebra operation and 85 minutes for a two-level surgical procedure. This study also reported that no patient stayed longer than 3 days after surgery.

In conclusion, MIS-DLIF is a promising procedure that has the potential with decreased rates of complications, reoperation (repeated surgery) and significantly reduced medical costs. More studies should be and are being conducted to follow-up on patient improvement and also for long-term follow-up.

References:

• Abbasi H, Abbasi A. Minimally invasive direct lateral interbody fusion (MIS-DLIF): proof of concept and perioperative results. Cureus. 2017; 9(1):e979.
• XLIF/DLIF. Watkins Spine. http://watkinsspine.com/xlifdlif/. Accessed 3/3/2017.